LONG READ: Infertility through the ages – and how IVF changed the way we think about it

To all outward appearances, Louise Brown looked exactly the same as thousands of other babies when her blinking, slightly quizzical gaze met newspaper readers on the morning of July 27, 1978. But as the first child born using the technique of in-vitro fertilisation (IVF), she was utterly unique in the history of humankind.

Forty years later, the media is saturated with articles about people’s experiences of infertility. There is frequent debate about the possible dangers of current and future reproductive technologies. These include intracytoplasmic sperm injection (the direct injection of sperm into eggs obtained via IVF), uterus transplants, artificial wombs and human cloning.

And there is good reason for news outlets to be concerned about infertility. It remains an immediate and painful problem for many people today. In 2010, an estimated 48.5m couples worldwide were infertile. We will never know how many people suffered from infertility in past generations – the numbers were never counted – but there are fears that rates are now rising.

Today, declining fertility rates are often blamed on wider changes in Western women’s lives in the early 21st century. The average age of first-time motherhood is rising in England and Wales and across most of Europe. The reasons behind this change are complex, but in Western Europe include increased educational and professional opportunities for women and changing models of family life. Childlessness is often perceived to be a direct result of these changes.

For these reasons, many people assume that infertility is a distinctively modern experience. Likewise, when they think about infertility, they think about modern medical approaches to its treatment. But the history of infertility goes back much further than 1978, and in the past people often did not think of it as a medical condition at all.

Men suffer from fertility problems too and there is increasing public debate on male infertility.

But looking back over a longer time frame shows that for most of history, women have been blamed for childlessness. In some ways this has not changed since 1978. Because IVF is a technology that intervenes on women’s bodies, it also reinforces the focus on how women’s reproductive systems might “fail”.

On the 40th anniversary of Louise Brown’s birth, it makes sense, then, to reflect on women’s experiences of infertility in past and present societies. This is a good time to consider the longer history of infertility – and how the experience of involuntary childlessness has changed.

A long history

It’s easy to forget that only a few decades ago, the birth of one baby via IVF was widely perceived as a scientific miracle. But writings and stories about infertility stretch back to the medical texts of ancient Egypt, Greece and beyond.

In centuries past, couples sought all kinds of remedies for childlessness. They prayed and went on pilgrimages. In medieval England, men and women took remedies containing the sexual organs of animals in the belief that this would stimulate their reproductive organs. In 18th-century Europe, childless women were encouraged to “take the waters” in spa towns to ease their nerves and prevent spasms of the womb. More recently, in the mid-20th century, doctors who believed that female infertility was a psychosomatic condition recommended adoption as a “cure”. They argued that becoming a mother to an adopted child made women relax and increased their chances of conception.

Behind the chant about the wives of Henry VIII that British schoolchildren learn in the playground – “divorced, beheaded, died; divorced, beheaded, survived” – there also lies a tale of the king’s desperate and bloody quest for more children. In the modern era, Federico García Lorca’s 1934 play, Yerma, recently reworked in a lauded production at London’s Young Vic theatre, charted one woman’s obsessive quest for motherhood – an issue that has featured in many TV soap opera storylines in recent decades.

Yet despite this historical evidence, many people persist in thinking about infertility as a product of the modern age. One reason is that IVF itself has made infertility socially visible to an extent unparalleled in earlier decades. Newspaper stories, government inquiries and oral histories show that in the 1950s and earlier, British couples often perceived the arrival of children as entirely down to chance. As one woman, born in 1943, told the oral historian Elizabeth Roberts: “Nature … it tricks you doesn’t it? I’ve always loved babies but you know I just never had any.”

With the first live birth of a baby conceived via IVF in 1978, such fatalism became less common. The media storm following Brown’s conception and birth (the Daily Mail reportedly paid the Browns £325,000 for exclusive rights to their story) put infertility in the public eye and encouraged other couples to proactively seek medical support and technological solutions to their childlessness. Some women about to undergo IVF now believe that the technology works for everyone. Many women are shocked to discover the relatively high rate of failure of a single cycle of IVF. The success rate for women under 35 to have a live birth is 32.2%, declining to just 1.9% for women over 44, according to NHS data from 2010.

In only 40 years, a technology once perceived as equivalent to a miracle has come to be seen almost as a cure-all for fertility problems. The arrival of IVF brought infertility as an issue into the public domain – and led people to believe it was a modern problem that could be solved. But there are other reasons, apart from IVF, why infertility feels like a late 20th-century phenomenon. It was part of a series of changes, which began nearly 20 years earlier, that altered the way women thought about their own bodies.

Choice and control

In Britain, the oral contraceptive pill was made available in 1961 and abortion was legalised six years later. Dramatic changes in women’s sexual, reproductive and family lives followed over the ensuing decades. As women were better able to plan and space out births, the birth rate plummeted and the average age of first pregnancy rose. At the same time, pre-marital sex, illegitimacy and divorce were on the rise. More married women now worked outside the home. The Women’s Liberation Movement proclaimed that women should take their futures into their own hands.

Above all, these developments resulted in a new sense that at long last, people might be able to control their reproductive futures. In practice, not all women could easily access contraception or abortion. It wasn’t until 1974 that the contraceptive pill was made available free on the NHS to all women, regardless of marital status or age. Nevertheless, throughout the 1960s and 1970s, public debates, social policy and political discourse emphasised choice and control. Because of this emphasis, infertility was often ignored.

For infertile couples, public ignorance around their plight was compounded by the fact that more effective family planning meant fewer newborn children were available for adoption. By the time Brown was born in 1978, a unique set of circumstances prevailed: social changes had encouraged women to believe they had power over their destinies, while technological advances had led to unprecedented faith in the power of women to control their fertility.

Yet at the same time, one of the traditional solutions to childlessness was being lost. While childless couples can still adopt today, they are likely to become parents to older children rather than babies. Child adoption is also now much more heavily regulated in England than it was in the early 20th century. Some couples are not deemed suitable to adopt, while others decide not to continue with the process after making initial enquiries.

Technology has the answers

It’s possible to trace this focus on technology back even further in time. Since the 1930s, it has been possible to detect pregnancy very early on by measuring the level of progesterone in women’s urine. Back then, the test was expensive to carry out, but in the late 1960s the home pregnancy testing kit was invented, and is now easily accessible in the West. In the 1950s, ultrasound was developed, and by the 1970s obstetricians were recommending use of the technique on all pregnant women.

This ability to visualise the foetus in the womb is taken for granted today, but it changed common perceptions of pregnancy beyond all recognition. But in previous centuries, this wasn’t the case. Early modern medical authorities tell us that there was often much uncertainty about the diagnosis of pregnancy. Take, for example, Mary Tudor’s phantom pregnancy in 1555. The queen of England fully believed that she was pregnant until long past her expected due date. She has sometimes been portrayed as delusional, driven mad with grief by her longing for a child. But her courtiers also believed that a royal birth was imminent, and the most up-to-date medical knowledge available at the time could not disprove them until the child failed to materialise.

In the mid-20th century, the march of technology seemed unstoppable. By the time IVF became available, as adoption became more difficult, couples were primed to pin their last hopes of raising a child from birth on a technological breakthrough. This is the vital context for understanding initial responses to IVF as a medical miracle. No one seemed to think it was genuinely possible until the late 1960s, yet previous advances such as the pill and ultrasound meant than when it arrived, people quickly trusted the new reproductive technology.

The belief in this miracle “cure” exerted considerable influence on the shape of public discussions of infertility in subsequent decades – not least in the unthinking confidence many couples have in IVF.

All this shows that to understand past experiences of infertility, we need to realise just how radically recent changes in medicine and technology have altered the way we think about the body. Infertile women now experience involuntary childlessness differently to their forebears. But the emotions women often go through when dealing with infertility remain remarkably similar, despite the advent of new technologies.

‘Not a proper woman’

This argument is at the centre of a recent history of infertility I co-edited with medical historian Gayle Davis, which spans the ancient world to the present day, taking in Britain, Europe, Asia and North America.

My own research compares depictions of infertility in British mass-market women’s magazines and in feminist publications in the 1960s and 1970s. Because of developments in contraceptive technology, the women featured in these publications often believed that they were now able to control their reproductive destinies. They were less prepared than women of previous generations for the possibility that they could be powerless to have a baby. But in a pre-IVF period, if they did experience difficulty in conceiving, there was no promise of an effective technological solution to the problem.

Desperation was the most constant theme in mass-market magazine coverage of infertility in this period. Women described infertility as a “tragedy”, a feeling of “emptiness”, and like being “dead inside”. They told of their inability to come to terms with the diagnosis, and their perception of infertility as an irreparable loss. One woman begged an agony aunt: “Can a woman ever come to terms with this tragedy? If so, tell me how?”

These women had expected to become mothers. Infertility was a loss of this anticipated future. More than this, they felt that childlessness meant a loss of feminine identity. The victim of infertility often described herself as “not a proper woman”. Above all, infertile women felt themselves separated from pregnant women and mothers.

One woman recounted standing “outside Mothercare, looking in the window with tears streaming down my face”, while others dreaded visiting friends who had recently given birth. These descriptions of infertile women’s emotions remained remarkably constant, despite the sweeping social changes of these two decades. And women reported similar emotions in feminist publications as in the mass-market magazines. Both before and after 1978, when Brown was born through IVF, infertile women expressed intense feelings of powerlessness and despair.

A history of stigma

It seems infertility has been stigmatised in many different historical contexts. Noble women in medieval Japan were disdained if their marriages remained childless. In 16th-century England, childless women suffered because motherhood was perceived as the most important marker of femininity. And in 19th-century France, many doctors linked childlessness to abortion, venereal disease, or promiscuity.

In widely different societies, women have borne the brunt of the blame for fertility problems. Yet in some circumstances, women have also been stigmatised for seeking help. In the mid 20th century, there was much debate over whether married women who conceived by use of artificial insemination by donor sperm had committed “adultery”. For much of history, it seems, childless women literally couldn’t win, no matter what they did.

Infertility is still often seen as a woman’s problem today. In the media, childlessness is often blamed on women’s “selfishness” in seeking to build careers or wait for the right partner before trying to become pregnant. A reality check is desperately needed to stop this cruel finger pointing. Men have fertility problems too. Not all women suffer fertility troubles because they start trying too late. But even when an age-related decline in fertility is the root of the problem – why should a woman be blamed for wanting to wait until she feels ready to be a good mother?

It might seem depressing to conclude that women have always been blamed for infertility. But maybe putting their own stories in historical perspective could help infertile women now. The ability to research and to understand the many different reasons for infertility, and the different options open to those who are unable to conceive, helps couples to exert control over a situation that makes them feel powerless.

This ability to exert increased control by making informed decisions about what path to take next has been identified as an important mechanism for coping with infertility. Understanding the history of infertility could have the same effect. Humans are historical creatures. The ability to place our own experiences in historical perspective could help those who cannot conceive to come to terms with their situation, and not to blame themselves.

We need to look beyond that famous photograph of Brown, a baby unaware of what she would come to represent for so many millions of people. Instead we should open our eyes and really look at the human face of infertility throughout history – to help people understand that in all ages, women and men have had to cope with this experience, and to learn from their struggles.

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